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J Thorac Cardiovasc Surg 2006;132:373-378
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: Results of a randomized longitudinal trial

Domingos S.R. Souza, MD, PhD a , * , Benny Johansson, MD b , Leif Bojö, MD, PhD c , Roland Karlsson, MD, PhD c , Håkan Geijer, MD, PhD d , Derek Filbey, PhD e , Lennart Bodin, PhD f , Mikael Arbeus, MD a , Michael R. Dashwood, PhD g

a Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, SE-701 85 Örebro, Sweden
b Department of Cardiology, Örebro University Hospital, SE-701 85 Örebro, Sweden
d Department of Radiology, Örebro University Hospital, SE-701 85 Örebro, Sweden
e Department of Transfusion Medicine, Örebro University Hospital, SE-701 85 Örebro, Sweden
f Department of Biostatistics, Örebro University Hospital, SE-701 85 Örebro, Sweden
c Cardiology Central Hospital, Karlstad, Sweden
g Department of Clinical Biochemistry, Royal Free Hospital, London, UK.

Received for publication November 29, 2005; revisions received April 6, 2006; accepted for publication April 11, 2006.

* Address for reprints: Dr Domingos S.R. Souza, Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, SE-701 85 Örebro, Sweden. (Email: domingos.souza{at}orebroll.se).

OBJECTIVE: Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure. A novel "no touch" technique provides high short- and long-term patency rates.

METHOD: This randomized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery. Conventional: 52 patients had their veins stripped, distended, and stored in saline solution. No-touch: 52 patients had veins removed with surrounding tissue, not distended, and stored in heparinized blood. Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups.

RESULTS: The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups. The angiographic assessment at 18 months postoperatively showed 89% conventional versus 95% no-touch grafts were patent. Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76% and 90% for the no-touch group (P = .01). The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting (odds ratio= 3.7, P = .007) for the no-touch versus the conventional technique and the vein quality before implantation (odds ratio = 3.2, P = .007) for veins that were of good quality. By comparison the patency of the thoracic artery grafts was 90%.

CONCLUSION: Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery.

Abbreviations and Acronyms C = conventional harvesting technique; I = intermediate harvesting technique; LAD = left anterior descending; NOS = nitric oxide synthase; NT = "no-touch" harvesting technique; OR = odds ratio; PDA = posterior descending artery; RA = radial artery; RCA = right coronary artery; SV = saphenous vein




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